Surgical Approach to Jugular Foramen Tumors (Infratemporal Fossa Type A)

Abstract Objective The jugular foramen is one of the most challenging surgical regions in skull base surgery. With the development of endoscopic techniques, the endoscopic endonasal approach (EEA) has been undertaken to treat some lesions in this area independently or combined with open approaches. The purpose of the current study is to describe the anatomical steps and landmarks for the EEA to the jugular foramen and to compare it with the degree of exposure obtained with the lateral infratemporal fossa approach. Materials and Methods A total of 15 osseous structures related to the jugular foramen were measured in 33 adult dry skulls. Three silicone-injected adult cadaveric heads (six sides) were dissected for EEA and three heads (six sides) were used for a lateral infratemporal fossa approach (Fisch type A). The jugular foramen was exposed, relevant landmarks were demonstrated, and the distances between relevant landmarks and the jugular foramen were obtained. High-quality pictures were obtained. Results The jugular foramen was accessed in all dissections by using either approach. Important anatomical landmarks for EEA include internal carotid artery (ICA), petroclival fissure, inferior petrosal sinus, jugular tubercle, and hypoglossal canal. The EEA exposed the anterior and medial parts of the jugular foramen, while the lateral infratemporal fossa approach (Fisch type A) exposed the lateral and posterior parts of the jugular foramen. With EEA, dissection and transposition of the facial nerve was avoided, but the upper parapharyngeal and paraclival ICA may need to be mobilized to adequately expose the jugular foramen. Conclusion The EEA to the jugular foramen is anatomically feasible but requires mobilization of the ICA to provide access to the anterior and medial aspects of the jugular foramen. The lateral infratemporal approach requires facial nerve transposition to provide access to the lateral and posterior parts of the jugular foramen. A deep understanding of the complex anatomy of this region is paramount for safe and effective surgery of the jugular foramen. Both techniques may be complementary considering the different regions of the jugular foramen accessed with each approach.

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Facial Nerve Schwannoma Extending to Jugular Foramen: A Case Report

Ear Nose & Throat Journal ◽

10.1177/01455613211000292 ◽

2021 ◽

pp. 014556132110002

Author(s):

Jiangyu Yan ◽

Fangfang Pan ◽

Mengmeng Zhen ◽

Yuan Ren ◽

Wenjuan Hao ◽

...

Keyword(s):

Facial Nerve ◽

Medical History ◽

Facial Palsy ◽

Infratemporal Fossa ◽

Tumor Resection ◽

Type A ◽

Jugular Foramen ◽

Lateral Muscle ◽

The Right ◽

Facial Nerve Schwannoma

Facial nerve schwannoma (FNS) is a benign, slow-growing schwannoma that originates from Schwann cells. Facial nerve schwannoma is the most common tumor of the facial nerve but rare and only accounts for 0.15% to 0.8% of intracranial neurinomas. It may be manifested as asymmetric hearing loss, facial palsy, and hemifacial spasm. A 56-year-old woman was transferred to our department, because of pain behind the right ear and spasm of the right lateral muscle for more than 2 years and pulsatile tinnitus for half a year. Based on the preoperative medical history, physical signs, and auxiliary examination, it was diagnosed with jugular foramen (JF) space-occupying lesion. We removed the tumor through the infratemporal fossa type A approach and found that the tumor originated from the facial nerve. After the tumor resection, sural nerve transplantation was performed. The patient demonstrated postoperative facial palsy (House-Brackman grade VI) and was smoothly discharged after good recovery. Facial nerve schwannoma rarely invades the JF, and the most common tumor in the JF is the glomus jugular tumor, followed by the posterior cranial schwannoma. They have common symptoms, making it difficult to obtain a correct diagnosis. Clinical data, medical history, and auxiliary examinations should be carefully analyzed to avoid misdiagnosis or mistreatment. Infratemporal fossa type A approach is an effective method for treating FNS of JF.

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Surgical Management of Class C and D Glomus Jugulare Tumors: Fisch Infratemporal Fossa Type A Approach

10.1055/s-0040-1702546 ◽

2020 ◽

Author(s):

Yin Xia ◽

Yubin Xue ◽

Ting Ye ◽

Xiaopeng Qu ◽

Xukun Yan ◽

...

Keyword(s):

Surgical Management ◽

Infratemporal Fossa ◽

Type A ◽

Glomus Jugulare ◽

Class C

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Anatomic Landmarks of the Glossopharyngeal Nerve: A Microsurgical Anatomic Study

Neurosurgery ◽

10.1227/01.neu.0000064807.62571.02 ◽

2003 ◽

Vol 52 (6) ◽

pp. 1400-1410 ◽

Cited By ~ 46

Author(s):

M. Faik Özveren ◽

Uğur Türe ◽

M. Memet Özek ◽

M. Necmettin Pamir

Keyword(s):

Choroid Plexus ◽

Fourth Ventricle ◽

Infratemporal Fossa ◽

Cranial Nerves ◽

Transverse Process ◽

Styloid Process ◽

Jugular Foramen ◽

Glossopharyngeal Nerve ◽

Lateral Recess ◽

Cochlear Aqueduct

Abstract OBJECTIVE Compared with other lower cranial nerves, the glossopharyngeal nerve (GPhN) is well hidden within the jugular foramen, at the infratemporal fossa, and in the deep layers of the neck. This study aims to disclose the course of the GPhN and point out landmarks to aid in its exposure. METHODS The GPhN was studied in 10 cadaveric heads (20 sides) injected with colored latex for microsurgical dissection. The specimens were dissected under the surgical microscope. RESULTS The GPhN can be divided into three portions: cisternal, jugular foramen, and extracranial. The rootlets of the GPhN emerge from the postolivary sulcus and course ventral to the flocculus and choroid plexus of the lateral recess of the fourth ventricle. The nerve then enters the jugular foramen through the uppermost porus (pars nervosa) and is separated from the vagus and accessory nerves by a fibrous crest. The cochlear aqueduct opens to the roof of this porus. On four sides in the cadaver specimens (20%), the GPhN traversed a separate bony canal within the jugular foramen; no separate canal was found in the other cadavers. In all specimens, the Jacobson's (tympanic) nerve emerged from the inferior ganglion of the GPhN, and the Arnold's (auricular branch of the vagus) nerve also consisted of branches from the GPhN. The GPhN exits from the jugular foramen posteromedial to the styloid process and the styloid muscles. The last four cranial nerves and the internal jugular vein pass through a narrow space between the transverse process of the atlas (C1) and the styloid process. The styloid muscles are a pyramid shape, the tip of which is formed by the attachment of the styloid muscles to the styloid process. The GPhN crosses to the anterior side of the stylopharyngeus muscle at the junction of the stylopharyngeus, middle constrictor, and hyoglossal muscles, which are at the base of the pyramid. The middle constrictor muscle forms a wall between the GPhN and the hypoglossal nerve in this region. Then, the GPhN gives off a lingual branch and deepens to innervate the pharyngeal mucosa. CONCLUSION Two landmarks help to identify the GPhN in the subarachnoid space: the choroid plexus of the lateral recess of the fourth ventricle and the dural entrance porus of the jugular foramen. The opening of the cochlear aqueduct, the mastoid canaliculus, and the inferior tympanic canaliculus are three landmarks of the GPhN within the jugular foramen. Finally, the base of the styloid process, the base of the styloid pyramid, and the transverse process of the atlas serve as three landmarks of the GPhN at the extracranial region in the infratemporal fossa.

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Lateral orbitotomy with extended osteotomy: a new surgical approach for infratemporal fossa tumours

International Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.ijom.2019.03.483 ◽

2019 ◽

Vol 48 ◽

pp. 156

Author(s):

I. Elimairi ◽

A. Salah ◽

A. Alnyal ◽

B. Musa

Keyword(s):

Surgical Approach ◽

Infratemporal Fossa ◽

Lateral Orbitotomy

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Hybrid Endovascular and Open Surgical Approach To An Acute Type-A Aortic Dissection In A Pregnant Female With Marfan Syndrome

Annals of Vascular Surgery ◽

10.1016/j.avsg.2020.01.049 ◽

2020 ◽

Vol 63 ◽

pp. 19

Author(s):

Spencer Hansen ◽

John Eidt ◽

Charles Roberts

Keyword(s):

Aortic Dissection ◽

Marfan Syndrome ◽

Surgical Approach ◽

Type A ◽

Pregnant Female ◽

Acute Type ◽

Type A Aortic Dissection ◽

Open Surgical Approach

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Infratemporal fossa schwannoma

Medicinski pregled ◽

10.2298/mpns1306250m ◽

2013 ◽

Vol 66 (5-6) ◽

pp. 250-253

Author(s):

Ivana Mijatov ◽

Bojan Pejakovic ◽

Benjamin Nalic ◽

Sasa Mijatov ◽

Aleksandar Kiralj

Keyword(s):

Case Report ◽

Surgical Treatment ◽

Success Rate ◽

Surgical Approach ◽

Infratemporal Fossa ◽

Complete Removal ◽

Accurate Diagnosis ◽

Primary Tumors ◽

Postoperative Course ◽

The Face

Introduction. Due to its contents and relations with neighboring regions, the infratemporal fossa has a great clinical significance. Primary tumors of this region, both benign and malignant, are rare, but they do require surgical treatment, which is determined by the size and localization of the tumor. Case Report. The paper presents the case of a 72-year-old female patient who was referred to hospital for paresthesia in the left half of the face after having been found to have a tumor of left infratmeporal fossa by imaging methods. The tumor was completely removed by transfacial-transzygomatic approach and, according to histopathological findings, it was a schwannoma. The postoperative course was without complications and the patient did not have any discomforts at the check-up a month later. Conclusion. In addition to the accurate diagnosis, the success rate of the surgical treatment of tumors depends on the appropriate surgical approach to ensure the complete removal of the tumor while preserving the content of the infratemporal region.

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Microsurgical and Endoscopic Anatomy of the Extended Retrosigmoid Inframeatal Infratemporal Approach

Operative Neurosurgery ◽

10.1227/neu.0000000000000632 ◽

2015 ◽

Vol 11 (1) ◽

pp. 181-189 ◽

Cited By ~ 1

Author(s):

Roberto Colasanti ◽

Al-Rahim A Tailor ◽

Mehrnoush Gorjian ◽

Jun Zhang ◽

Mario Ammirati

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Infratemporal Fossa ◽

Cranial Nerves ◽

Jugular Foramen ◽

Sigmoid Sinus ◽

Mean Width ◽

Infratemporal Approach ◽

Cervical Internal Carotid Artery

AbstractBACKGROUNDDifferent and often complex routes are available to deal with jugular foramen tumors with extracranial extension.OBJECTIVETo describe a novel extension of the retrosigmoid approach useful to expose the extracranial area abutting the posterior fossa skull base.METHODSA navigation-guided, endoscope-assisted retrosigmoid inframeatal approach was performed on 6 cadaveric heads in the semisitting position, displaying an area from the internal acoustic meatus to the lower cranial nerves and exposing the intrapetrous internal carotid artery. We then continued removing the temporal bone located between the sigmoid sinus and the hearing apparatus, reaching the infratemporal area just lateral to the jugular fossa. This drilling, which we refer to as posterolateral inframeatal drilling, has not previously been described. Drilling of the horizontal segment of the occipital squama allowed good visualization of the uppermost cervical internal carotid artery, internal jugular vein, and lower extracranial cranial nerves.RESULTSWe were able to provide excellent exposure of the inframeatal area and of the posterior infratemporal fossa from different operative angles, preserving the neurovascular structures and the labyrinth in all specimens. The intradural operative window on the extracranial compartment was limited by the venous sinuses and the hearing apparatus and presented a mean width of 8.52 mm. Sigmoid sinus transection led to better visualization of the lateral half of the jugular foramen and of the uppermost cervical internal carotid artery.CONCLUSIONThe navigation-guided endoscope-assisted extended retrosigmoid inframeatal infratemporal approach provides an efficient and versatile route for resection of jugular foramen tumors with extracranial extension.

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